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In this randomised, controlled, non-inferiority trial, Indigenous Australian children aged 3 months to 13 years with purulent or crusted non-bullous impetigo were randomly assigned (1:1:1) to receive benzathine benzylpenicillin (weight-banded injection), twice-daily co-trimoxazole for 3 days (4 mg/kg plus 20 mg/kg per dose), or once-daily co-trimoxazole for 5 days (8 mg/kg plus 40 mg/kg per dose). At every visit, participants were randomised in blocks of six and 12, stratified by disease severity. Randomisation was done by research nurses and codes were in sealed, sequentially numbered, opaque envelopes. Independent reviewers masked to treatment allocation compared digital images of sores from days 0 and 7. The primary outcome was treatment success at day 7 in a modified intention-to-treat analysis. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000858291.
As part of an intensive program of surveillance for adverse drug reactions in general pediatric outpatients, 2,714 courses of oral antibiotic therapy were monitored for the occurrence of gastrointestinal (GI) adverse drug reactions. Using a recently developed algorithm to establish a causal link between drugs and adverse symptoms, the risks of diarrheal or upper GI tract adverse drug reactions were found to vary considerably with different antimicrobial agents and, for several agents, according to the administered dosage. For diarrhea, the risk was lowest with sulfasoxazole and trimethoprim/sulfamethoxazole and was highest with cloxacillin. A significant dose-response effect was found with both amoxicillin and trimethoprim/sulfamethoxazole. For upper GI tract adverse drug reactions, the risk was again lowest with sulfasoxazole and trimethoprim/sulfamethoxazole and was highest with erythromycin. Knowledge of the risks of gastrointestinal adverse drug reactions with different agents and different doses should be clinically helpful in assessing risks and benefits when oral antibiotics are prescribed for children.
The overall incidence and type of serious adverse reactions to trimethoprim-sulfamethoxazole among infants and children with HIV infection appear to be similar to those among adults.
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Methods of preventing the infectious complications that occur in patients undergoing therapy for cancer have been the focus of considerable research. Because infections arise from both the endogenous microbial flora and newly acquired organisms and because the pathogens include bacteria, fungi, viruses, and/or parasites and affect a number of different body sites, it has been difficult to conceive of a single or simple method of controlling these multiple infectious etiologies. The suppression or elimination of the host's own microbial flora by the use of various prophylactic antibiotics and the reduction in the patient's acquisition of new organisms by the use of isolation techniques have received the greatest attention. While a number of these approaches (including total protected isolation, nonabsorbable antibiotics, trimethoprim-sulfamethoxazole, selective decontamination, and most recently the quinolones) have appeared to reduce the incidence of infections, few have stood the test of time. The advantages and disadvantages of each of these methods are reviewed, and newer promising areas for current and future investigation are considered.
An 18-year-old boy with X-linked chronic granulomatous disease (CGD) developed Aspergillus fumigatus pneumonia and multifocal osteomyelitis. Treatment with amphotericin B resulted in only moderate improvement of the lesions and was accompanied by considerable toxicity. In contrast, administration of the new triazole drug itraconazole led to complete disappearance of all signs of infection. We conclude that itraconazole may be a valuable new drug for treating invasive aspergillosis in patients with CGD, although the duration of treatment remains to be established.
Trimethoprim/sulfamethoxazole and azithromycin combination is an effective and safe treatment modality for the treatment of ocular toxoplasmosis.
Nasopharyngeal carriage of S. pneumoniae and H. influenzae was high in healthy schoolchildren. Stratified analysis showed that nasal carriage of pneumococci in urban children was significantly lower than in rural children [46.8% vs. 53.2%, P<0.001]. Carriage rates of H. influenzae in male and female populations were significantly different (47.8% vs. 52.3%, P<0.04). Penicillin resistance in S. pneumoniae was found low (3.3%), but 22.9% of H. influenzae isolates were ampicillin resistant. Resistance to co-trimoxazole was very high in both S. pneumoniae (81.8%) and H. influenzae (67.3%).
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Classical treatment of listeria infections of the brain and spinal cord has included ampicillin in combination with gentamicin and chloramphenicol. Antibiotic resistance to L. monocytogenes is extraordinarily low, and the combined risks of nephrotoxicity, ototoxicity, and agranulocytosis in an already critically ill patient make the potential use of trimethoprim-sulfamethoxazole monotherapy for coverage or treatment of listeria an important alternative.
Sulfamethoxazole-trimethoprim (co-trimoxazole) or placebo for seven days.
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The aim of the present was to evaluate the incidence of side effects to Trimethoprim-sulphamethoxazole (TMP-SMX) in 32 patients with AIDS and pneumonia by Pneumocystis carinii.
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Data from 12 cases of kidney transplant recipients who developed pneumocystosis were analyzed by clinical symptoms and signs, results of laboratory examination, imaging, bronchoscopy and biopsy. Combined TMP/SMZ was used for the prevention and treatment.
is cozole an antibiotic
A retrospective review was performed of patients diagnosed with Pneumocystis carinii pneumonia (PCP) from 1994 to 2003 at the Prince of Wales Hospital in Hong Kong. Eighteen patients were identified. Six (33.3%) were co-infected with human immunodeficiency virus (HIV). The remaining 12 non-HIV-infected patients had underlying diseases: three post-renal transplant recipients, three with haematological malignancies, two with auto-immune diseases, two with renal diseases, one with hepatocellular carcinoma and one with congenital cytomegalovirus disease. Cytomegalovirus co-infection was observed in four patients. All patients received cotrimoxazole therapy, with intolerance observed in four of them, including one with glucose-6-phosphate dehydrogenase deficiency, two with repeated vomiting and one with renal impairment. Overall crude mortality was 33.3%. The results suggested that, apart from being a common infection for patients with HIV infection, PCP can occur during the course of many immunosuppressive diseases and therapies. The mortality of PCP was high despite appropriate treatment. Chemoprophylaxis should be considered in populations at risk.